The price of miracles

May 1986

The closing for lack of funds of several wards in one of London's most prestigious hospitals has hit the headlines in recent weeks, and understandably so. Most people -- certainly most
P.L. members -- are appalled at this kind of wholesale retrenchment in an area as vital as that of the nation's health. They see it as a glaring indictment of.......

Well, of what? The obvious target, of course, is our present government. Mean, stingy, heartless, uncaring -- these are only some of the epithets being hurled at those currently in charge of the Health Service and its funding. Abuse is easy, and no doubt relieves feelings of outrage; but, alas, it also tends to obscure the real and intractable problems facing Western medicine in its present form, and which no government, stingy or otherwise, has the power to answer.

Let me explain.

There is a myth in many people's minds that a satisfactory level of health care is in fact possible, and that if only we had enough doctors, enough nurses, enough medical research, and enough money to pay for it all, then this satisfactory level could be reached and sustained.

Alas, this is not so: it is, in fact, a logical impossibility for the simple reason that every medical success is liable to entail more rather than less subsequent expenditure. If you save a man from dying of a heart attack in his forties, he will live on to have another heart attack at some later date, requiring intensive care all over again; and in the interim period he will have needed a large number of check-ups, not to mention spectacles, dentures, a hip-replacement and maybe a prostate operation. The long-term costs to the Health Service of having saved him from that original heart attack are going to be enormous. This is not, let me hasten to say, any sort of attack on the ethical rightness of saving him in the first place: it is a simple statement of the economic consequences of doing so.

Of course, to set against this, there are cases where medical treatment will turn an expensive long-term invalid into a healthy, active citizen; but such cases are numerically a good deal fewer than those in which the patient, having been saved from disaster, is going to require intermittent long-term care of one sort or another. The net effect of most medical treatment is to entail a need for more medical treatment.

I have mentioned medical research. This again poses a financial dilemma which no government, however generous, will easily resolve. In fact, the more generous they are, the more intractable will the problem become, for with every new discovery comes the need for expensive new techniques, and the expensive training of technicians to apply them.

Take, for example, the case of premature babies. A few weeks ago we were shown on Television a heart-warming picture of an apparently normal one-year-old who had weighed barely a pound at birth. A very few years ago, a baby of this weight could not possibly have survived. Today, with the aid of incredibly expensive new techniques and apparatus, saving such a baby becomes possible. And since it is possible, it has to be done. The survival of this particular baby is at the moment a medical miracle; but rest assured, it won't be for long; instead, it will be a crying scandal that there aren't enough high-tech premature units for all babies of this weight. Mrs Thatcher (or whoever) will be accused of intolerable meanness in not funding prematurity units on this scale in every hospital in the land. It is a sobering thought that if she had been meaner still, and had never funded research into premature babies in the first place, the problem would never have arisen.

Remember the first kidney machines -- that medical miracle of a few decades ago? When the first patient was saved by this novel means, it was in a blaze of publicity, and to a chorus of admiration all over the world. There is no chorus of admiration now -- rather there are howls of outrage that not every kidney sufferer can have immediate access to one of these appliances. The passage from medical miracle to crying scandal seems to take on average between ten and fifteen years, and the period is likely to shorten as medical research accelerates.

So what to do? In case anyone should suppose that all this is some sort of devious plea for private medicine, let me point out that the forces I have been describing would bedevil a private health scheme every bit as much as they do a public one, with medical treatment fast pricing itself out of the market even for the rich.

I don't know the answer. But what I do think is that the P.L. should be giving some hard and careful thought to the real dilemmas of health care in the modern world. Simply screaming with rage at whoever happens to be in power (and soon it may be the Labour Party, or the Alliance) will get us absolutely nowhere.